Kudos on your conference. Well run and concise, interesting
information. Just the right amount of content within the time
allotted which gives me ideas for the future.

Great size with respect to number of attendees and overall length of
each session

I
liked that the summit was small and intimate, giving me an
opportunity to network with a majority of the speakers and
attendees. I also enjoyed the format of the panel discussions, very
open and candid.

Content and networking

All
of the conference was great

The
format

Ray
Pentecost

Size
(of event), (Ray) Pentecost & (Nick) Reddy

The
speakers were very engaging and the content was relevant and
interesting.

Discussion on future of healthcare technology

Industry Partners

Takeaway Messages

June 19,
2019 - Dallas, TX

Reported by Linda Stallard Johnson
(rightondeadline@gmail.com), a freelance writer and editor in
the Dallas-Fort Worth area. She is a veteran of The Dallas
Morning News and Houston Chronicle, and currently edits AIA
Dallas’ quarterly magazine.

The
Physician
Shortage and
How an
Optimal
Workspace Is
Key to
Physician
Retention

The physician shortage will get worse
before it gets better. While the U.S. population both grows
and ages, there are too few doctors to meet the need. In
about 10 years, the entire country will be as old, on
average, as Florida is today. However, “we didn’t know we’d
be living longer.” As a result, forecasts have fallen far
short on the demand for doctors.

Doctors also are aging and retiring,
and they’re being replaced too slowly. “We have a 30%
increase in medical students in America. We have only a 6%
or 7% increase in residencies. You have to have a residency
before you become a physician.” International physicians and
creative solutions such as Missouri’s assistant physicians,
who practice without a residency, are helping ease the
bottleneck.

Medical facilities must adapt to
demand. Patients 65 and up account for 14% of the
population, but 34% of inpatient procedures and 37% of
diagnostic tests. Think about bariatrics, Botox and Boomers,
Mosley advised, as weight loss and plastic surgery are big
with this age group.

Millennials are driving new trends.
Many don’t have a primary care physician, helping give rise
to urgent care centers and drugstore clinics. But do they
mean the end of the primary care office?

Health systems must rethink how to
attract and retain doctors. Doctors want efficiencies
(scribes and glitch-free electronic health records), the
openness to speak up about concerns, financial opportunity
and an appealing space laid out well for patients and near
specialists and labs.

Facilities have a huge impact on
physician retention. A doctor is an economic engine
generating over $2 million in revenue a year, especially
important for small towns. Remember that you oversee the
facilities where that physician spends the day. You might
lure a doctor with six weeks off to go surfing, but you
might lose one by not assigning parking near the hospital
operating room.

The
spread
of
technology
is
occurring
“faster
than
anything
in
mankind,
more
deeply
and
quickly”
than the
agricultural
and
industrial
revolutions.
“The
world
has
changed,
the
economy
has
changed.”
In
particular,
watch
where
venture
capitalists
put
their
money in
healthcare.

Artificial
intelligence
(AI) is
the next
big
thing.
“In
1996,
Bill
Gates
said the
most
underhyped
thing
that
he’d
ever
seen was
the
Internet.
Last
year,
Bill
Gates
said the
most
underhyped
thing in
the
world is
artificial
intelligence.”

AI
applications
are
developing
rapidly.
Reddy
sees
this in
“digital
pets”
that
combat
loneliness
in the
elderly;
faster,
cheaper,
more
accurate
X-ray
readings
than
possible
from
radiologists;
and an
entrepreneur
who is
building
a
“doc-in-your-pocket”
that
shows
how sick
a person
is.
“He’s
done
scans
through
the
phone,”
Reddy
said.

The
future
is now
in
business
technology
and
strategies.
“Are you
making
the line
go
faster
at
Blockbuster
or are
you
building
Netflix?”
It’d
better
be
Netflix,
and it
better
put the
customers
–
patients
and
doctors
– first.
And
pricing
transparency
will be
key.

Healthcare
systems
are at
risk for
disruption.
Despite
7
million
users of
its
platform
and
“more
digital
visits
than we
have
physical
visits,”
Baylor
is
working
on
“virtualizing”
40% of
its
business
in the
next
five
years.
“Either
we
virtualize
it or
some kid
out in
California
wearing
skinny
jeans
and a
white
T-shirt
will.”

Get your security personnel involved
in designs early. Security professionals can quickly
spot problems, such as an underground garage for delivery
trucks that could also attract a bomber. In addition to
preventing costly retrofits that detract from the
architectural feel, they can suggest solutions as simple as
planting hedges to steer pedestrians along.

Sometimes security and life safety
codes are at odds. “As a police officer, I love to be
able to shut down doors and lock and contain people in an
area, but people have a right to egress, a right to get out
in case of fire or emergencies,” Johnson said.

Create a technology master plan.
“Do we have an understanding of the technology we want, how
are we going to use that technology, who can view that
technology, all these things that go back to the policy and
procedure?” Nibbelink asked. “Does it protect the pharmacy
and the narcotics, does it help protect the ICU or the
pediatrics?” A technology master plan should involve “a lot
of people in your institution, not just security.”

Managing aggression starts at the
curb. Architects need to keep designs clear of obstacles
that frustrate the person in pain or the frantic relative
trying to enter the facility, Johnson said. That begins with the
right amount of parking, climate-controlled elevators in the
garages and easy wayfinding.

Get “down and dirty” talking about
active shooters with staff. Go over the physiological
reactions and the “stupid things” people do in such
situations. In hospitals, where many rooms don’t lock or gun
smoke might disarm magnetic locks, employees should have “go
bags” with chains, locks and anything else that might thwart
a shooter. Drill on “barricade, barricade, barricade,”
Johnson said.

Internet of
Things:
Maximize the
Benefits
While
Minimizing
Risks to
Patients and
Healthcare
Facilities

The
Internet
of
Things
(IoT) is
exploding
in
buildings.
Thermostats,
lights,
HVAC
system,
not to
mention
medical
devices,
are all
connected
to your
wireless
carrier,
just
like
your
phone
and your
laptop.
In turn,
they are
connected
to a
hardwired
system.
And all
face
cybersecurity
risks.

Healthcare
is
seeing a
huge
adoption
of IoT.
Insulin
pumps,
pacemakers,
MRI
machines,
bone
density
machines
as well
as the
conditions
in a
patient’s
room are
churning
out
information.
“But
we’re
only
seeing
about
10% of
the
actual
data
being
used
today.”
This
data is
paving
the way
toward
machine
learning
and
artificial
intelligence,
which
won’t
require
a human
to
adjust
lights,
thermostats
and
other
settings.

By next year, up to 20% of your information security budget will go to securing your facility’s IoT connections. The threats are external – ransomware, malware, ID theft — but also internal, from disgruntled employees or the worker who plugs an infected USB stick of family photos into a corporate laptop. A total shutdown can cost a 200-bed hospital $1 million every eight hours.

Network segmentation is key. Put different types of users on different networks to reduce risks to your system — guests on one network, remote employees on another and a secure remote access point for outside vendors. Don’t have one username and password for 30 people. Know who logs in, the amount of time spent in the session, and what that person is doing.

In RFPs, be specific on cybersecurity. Include how you want the system and the connections managed. “Work with product manufacturers that are building cybersecurity features and capabilities into their products … because somebody - with a simplified wire transmitter and a Pringles can - sitting across the street can change insulin levels on that pump with four mouse clicks.”

Numbers and trends matter in picking
an MOB location. “We look at the market demographics but
also psychographics. Not just who you are, but what you are
and what your lifestyle is,” Carter said. “Will a location
last five years, 15 years, 30 years? Hospitals are looking
at it like a McDonald’s and Burger King.”

Consider what’s popping up around a
location. Alphonso was involved in a building purchase
that took place a year before a Costco went in nearby. “It
amazes me how excited people were about the Costco... What
that means is a submarket that adds value to the
building,” he said.

Plant a seed for growth and see if it
flourishes. Beckey said that Children’s is using a
time-share model for pediatric primary care and specialties.
As a “seedling” grows from occupying an office a half-day a
week to several days a week, “we take a harder look at
full-time residence. We’re doing that for a cardio in
Tyler,” he said.

Cater to the culture and needs of
nearby families. In some cultures, when one family
member goes to the doctor, the children and grandparents
also come along. “What we’re seeing a lot of is
multi-specialty care,” Carter said. In Bedford, N.J.,
Alphonso’s company built a 65,000-square-foot outpatient
facility that has a playground for bored children and is
near a regional mall so parents can take the kids off-site
during long waits.

Avoiding
Compliance
Pitfalls in
Clinics &
MOBs and
Their Impact
on
Reimbursements
and
Valuation

Competition
for
physician
groups
drives
up
compliance
risks.
Hospital
systems
are so
aggressive
in
luring
doctor
practices
“that
they
will do
it at
almost
any
cost,”
Trabold
said.
Due
diligence
is a
must to
avoid
illegal
inducements
or
violations
of
anti-kickback
and
Stark
laws.
Otherwise,
noncompliance
fines
can cost
hundreds
of
millions
of
dollars.

“Put
together
the
right
team of
individuals
to help
you
figure
out due
diligence,”
Walker
said.
The team
will
take a
hard
look to
see if
the
asset
you want
to
acquire
is
compliant
as well
as a
good
fit.
Don’t
think
you can
rush
into a
deal,
then
worry
about
compliance
later.

CMS
reimbursements
ride
on “the
purpose
for the
space”
in
leases
and
documentation,
Wood
said.
“Conditions
of
payments
are very
different
for a
physician
clinic
versus a
hospital
outpatient
department
that may
have a
surgery
component,
that may
have a
lab
component.”

Documentation
is
crucial.
As a new
tenant,
“I want
language
in that
lease
that
covers
us
completely
in terms
of
compliance
and our
CMS
criteria,”
Walker
said. If
a life
safety
survey
finds a
leftover
fire
hazard
or other
issue
that you
didn’t
know
about,
“now
we’re in
a very
dark
place in
terms of
managing
that”
for lack
of
paperwork.

Do
you even
have a
lease?
That’s
tops on
Trabold’s
list of
common
lease
deficiencies.
Others
include
expired
leases
or
leases
that one
party
didn’t
sign.
Compliance
hot
buttons?
Not
paying
market
rates on
rent and
paying
only on
your
10-by-10-foot
office
but not
the
restrooms
or other
common
areas.

Healthcare
facilities
must
balance
high-tech
with
human
touch.
Technology
improves
how
patients
move
through
a clinic
or
hospital
but,
bottom
line,
“these
are
spaces
for
humans
to heal
in,”
Schmitz
said. At
check-in,
for
example,
some
patients
prefer a
kiosk
but
others
“want to
see a
person
behind a
desk,”
Moore
added.

Designers
should
strive
to
reduce a
patient’s
stress.
Spaces
should
facilitate
conversation
between
the
provider
and
patient,
Schmitz
said.
Make
parking
and
wayfinding
easy,
especially
with
technology
that
alerts
patients
to open
parking
spots
and even
lets
them
reserve
a space,
Moore
said.

Rethink
the
waiting
room.
Go
beyond
providing
Wi-Fi
and give
patients
the
freedom
to wait
where
they
want,
Schmitz
and
Moore
said.
Phone
apps and
RFID
pagers
like
those at
restaurants
can
summon
patients
from,
say, the
building’s
coffee
shop. In
surgical
waiting
rooms,
loved
ones can
get
updates
— “now
they’re
in
surgery,
now
they’re
in
post-op,
now you
can see
them,”
Moore
said.

Here’s
the
latest
tech —
and
what’s
coming:
The
technology
is here
for LED
lighting
that
also
disinfects.
Next up:
Li-Fi,
using
light to
transmit
data
even
faster.
RTLS
(Real-time
Location
Systems)
will
track
patients,
caregivers
and
assets.
Paired
with a
tag on a
caregiver’s
wrist or
badge,
the soap
dispenser
“will
recognize
that
Nurse
Johnson
or Dr.
Smith
came up
and
washed
their
hands”
before
entering
a
patient’s
room,
Moore
said.

Technology
can
build
profit
and
brand.
After a
positive
experience,
a
patient
might
post a
review
or
pictures
of a new
baby at
the
hospital
on
social
media.
“This
completes
the
circle
because
now the
patient
is the
one
creating
that
brand
for a
hospital,”
Schmitz
said.
With a
good
experience,
patients
may rate
hospitals
higher
on the
Hospital
Consumer
Assessment
of
Healthcare
Providers
and
Systems
survey,
increasing
reimbursements.

Work
with a
partner
to
manage
the
technology
avalanche.
Consider
hiring a
technology
program
manager
who
knows
technology,
healthcare,
and
design
and
construction
to
prevent
issues
falling
between
the
cracks
of
silos.

Platform
is the
new
system.
The old
healthcare
model is
doing
“procedures
to get
paid to
keep the
doors
open.”
Today,
the push
is
keeping
people
healthy
and out
of the
doctor’s
office.
Healthcare
must
evolve
into a
platform
like
Amazon,
Starbucks
and
Netflix.
Platforms
find a
niche,
identify
an
audience
and
build
trust
through
interactions
– on
their
way to
selling
far
more.

Opportunity
is in
community
health,
not
reimbursements.
Virtual
care and
telemedicine
reach
people,
monitor
them and
track
them.
“Almost
96% of
what
happens
in our
medical
industry
doesn’t
need a
hospital.”
Add in
virtual
visits,
and only
0.13% of
Kaiser
Permanente’s
patient
experiences
are in
the
hospital.
Of the
12,000
children
that
Israeli
telemedicine
firm
Clalit
handles
each
month,
18% are
sent to
the
hospital
and less
than a
third
are
admitted.

Your
Fitbit
is a
window
on the
future.
Artificial
intelligence
and
augmented
medicine
are now.
A
cardiologist
got an
email
from a
patient:
“I’m in
atrial
fib.
What do
I do
now?”
The
patient’s
phone
not only
recorded
the
data, it
interpreted
it.
There
are 100
billion
connected
devices,
with
each
device
having
at least
a dozen
sensors,
creating
the
trillion-sensor
economy.

AI
also
affects
the
design
of
health
facilities.
For
designers,
the
competition
may be a
booth on
a street
corner.
In a
soundproof
compartment
on one
side of
China’s
Good
Doctor,
a
patient
tells
the AI
his
symptoms;
the
other
side
dispenses
medicine
after a
quick OK
by a
human
doctor.
Aditazz,
a
Silicon
Valley
company,
is
advancing
parametric
design.
“Give
the
computer
enough
parameters,
and
it’ll
draw a
building
around
it,”
then
whip out
a
client’s
revisions
within
minutes.

The
brain-computer
interface
is
coming:
Big
names —
Elon
Musk,
Mark
Zuckerberg,
DARPA
—are
getting
involved.
In time,
you may
see a
virtual
map
overlaying
the
actual
streets
as you
drive
or, at a
conference,
see a
brief
bio next
to each
person
you
encounter.